MDCalc

Small Intestinal Bacterial Overgrowth

Official guideline of the American College of Gastroenterology.

These guideline summaries are shared for educational purposes only and are not intended to direct patient care. For detail on the specific recommendations and information about the evidence considered by the guideline developer, we encourage you to go to the original guideline statement cited below.

Diagnosis

Diagnosis
Conditional recommendation
Very low quality evidence
We suggest the use of breath testing (glucose hydrogen or lactulose hydrogen) for the diagnosis of SIBO in patients with IBS.
Conditional recommendation
Very low quality evidence
We suggest using glucose hydrogen or lactulose hydrogen breath tests for the diagnosis of SIBO in symptomatic patients with suspected motility disorders.
Conditional recommendation
Very low quality evidence
We suggest testing for SIBO using glucose hydrogen or lactulose hydrogen breath tests in symptomatic patients (abdominal pain, gas, bloating, and/or diarrhea) with previous luminal abdominal surgery.

Other Conditions Associated with SIBO

Other Conditions Associated with SIBO
Conditional recommendation
Very low quality evidence
We suggest against the use of breath testing for the diagnosis of SIBO in asymptomatic patients on PPIs.
Conditional recommendation
Very low quality evidence
We suggest testing for methane using glucose or lactulose breath tests to diagnose the overgrowth of methane-producing organisms (IMO) in symptomatic patients with constipation.

Treatment

Treatment
Conditional recommendation
Low quality evidence
We suggest the use of antibiotics in symptomatic patients with SIBO to eradicate overgrowth and resolve symptoms.
Literature
Original/Primary Reference
Research PaperPimentel M, Saad RJ, Long MD, Rao SSC. Acg clinical guideline: small intestinal bacterial overgrowth. Am J Gastroenterol. 2020;115(2):165-178.